Medicare Benefits: What Medicare Covers for Your Health Care Needs?

Medicare benefits: About 20% of Americans are covered by Medicare, which is a very important program. Knowing what Original Medicare, which includes Parts A and B, covers is important for making smart decisions about your health care.

Medicare Part A usually pays for hospital stays, care in skilled nursing facilities, hospice care, and some home health care. Part B of Medicare covers care that doesn’t happen in a hospital. This includes visits to the doctor, preventive services, lab tests, and medical equipment.

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Medicare benefits: Medicare Coverage and Eligibility

Medicare does pay for some services, but you might have to pay deductibles, copayments, or coinsurance up front. You should know about them. You must also legally live in the United States in order to get Medicare.

Not all medical services are covered by original Medicare, so unless you have other insurance, you may have to pay out of pocket for some services. Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) do not cover many goods and services.

For instance, Medicare does not cover massage therapy, cosmetic surgery, or long-term care services because they are deemed non-essential. Additionally unexplored are concierge care (direct, subscription-based care models) and routine physical examinations.

Medicare usually does not cover certain medical needs, such as eye exams for glasses and hearing aids and their fitting exams. Additionally not included are dental services like regular cleanings, fillings, and extractions.

However, some dental procedures that are directly related to more extensive medical treatments, like dental work required during an organ transplant, cancer surgery, or heart valve repair, may be covered by Original Medicare.

Some of these exclusions, however, like specific vision, hearing, and dental benefits, might be covered if you’re enrolled in a Medicare Advantage Plan (Part C), a Medicare Cost Plan, or a Program of All-inclusive Care for the Elderly (PACE).

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Who decides what qualifies and what doesn’t?

There are three main things that determine who can get Medicare coverage: federal and state laws, Medicare’s national coverage decisions, and local coverage decisions made by businesses.

To find out why you might need certain services or supplies and if Medicare will pay for them, you can ask your doctor to explain coverage for specific needs.

It is also a good idea to check Medicare’s information to make sure that certain goods, services, or supplies are covered.